TNF-α levels in hypertensive patients with type 2 diabetes mellitus with and without obesity

Background. Patients with carbohydrate metabolism disorders and hypertension (HTN) are very often overweight and obese. Thus, the combination of HTN with obesity is extremely unfavorable, the frequency of which is constantly increasing. In turn, obesity, as an independent metabolic disease, is associated with hyperinsulinemia (HI) and insulin resistance (IR). The pathogenesis of IR in visceral obesity is heterogeneous and is due to the presence of genetic, gender, age, hormonal influences, and other factors. The development of inflammatory processes in obesity is accompanied by a parallel increase in the content of cytokines – mediators of inflammation, including tumor necrosis factor-alpha (TNF-α), which is associated with an increased risk of developing and progressing type 2 diabetes mellitus (DM), and a corresponding increase in the incidence of cardiovascular complications associated with this. Purpose – of the study was to investigate changes in the concentration of proinflammatory adipocytokine (TNF-α) in patients with hypertension with concomitant type 2 diabetes mellitus in combination with and without obesity. Materials and Methods. The study included 94 patients who were divided into 3 groups. Group 1 consisted of patients with HTN (comparison group, n = 25), group 2 consisted of patients with HTN and type 2 DM (n = 35), group 3 consisted of patients with HTN, type 2 DM and obesity (n = 33). In all groups, anthropometric and hemodynamic parameters were measured, the state of carbohydrate metabolism, insulin resistance index and plasma levels of the proinflammatory adipocytokine TNF-α were determined. Results. When evaluating the indicators of carbohydrate metabolism in the groups, a statistically significant increase in fasting glucose levels was observed between group 1 and group 2, p < 0.05, as well as between group1 and group 2, p < 0.05). Index IR (HOMA-IR) was statistically significantly different when comparing the group with HTN, type 2 DM and without obesity with another group with obesity, p < 0.05. Studying the levels of the proinflammatory adipocytokine TNF-α, it was noted that this marker increases with deterioration of carbohydrate metabolism, and an increase in body weight and glucose levels correlate with an increase in the concentration of TNF-α (r = 0.343, p = 0.020; r = 0.041, p = 0.013). Conclusions. The study demonstrated that obesity aggravates carbohydrate metabolism disorders and the course of hypertension (blood pressure levels). The correlation between the increase in the concentration of TNF-α with the presence of obesity and the deterioration of carbohydrate metabolism (glucose, insulin, HOMA-IR index) was established.